Classical Renin-Angiotensin system in kidney physiology

The renin-angiotensin system has powerful effects in control of the blood pressure and sodium homeostasis. These actions are coordinated through integrated actions in the kidney, cardiovascular system and the central nervous system. Along with its impact on blood pressure, the renin-angiotensin system also influences a range of processes from inflammation and immune responses to longevity. Here, we review the actions of the "classical" renin-angiotensin system, whereby the substrate protein angiotensinogen is processed in a two-step reaction by renin and angiotensin converting enzyme, resulting in the sequential generation of angiotensin I and angiotensin II, the major biologically active renin-angiotensin system peptide, which exerts its actions via type 1 and type 2 angiotensin receptors. In recent years, several new enzymes, peptides, and receptors related to the renin-angiotensin system have been identified, manifesting a complexity that was previously unappreciated. While the functions of these alternative pathways will be reviewed elsewhere in this journal, our focus here is on the physiological role of components of the "classical" renin-angiotensin system, with an emphasis on new developments and modern concepts.

Measurement and estimation of GFR in children and adolescents

GFR is the best indicator of renal function in children and adolescents and is critical for diagnosing acute and chronic kidney impairment, intervening early to prevent end-stage renal failure, prescribing nephrotoxic drugs and drugs cleared by a failing kidney, and monitoring for side effects of medications. Renal inulin clearance was the gold standard for GFR but is compromised by lack of availability, difficult assays, and problems of collecting timed urine samples, especially in children with vesicoureteral reflux or bladder dysfunction. Creatinine clearance-based estimates of GFR are often used in pediatrics. The addition of cimetidine to eliminate creatinine secretion permits accurate measurement of GFR in those who can completely empty their bladders to provide timed urine collections. Radioisotopes are used in plasma disappearance GFR determinations; however, these are not ideal for use in children, especially for repeated studies. The plasma disappearance of iohexol serves as a promising alternative GFR marker, because it is safe and not radioactive, easily measured, not metabolized or transported by the kidney, and excreted primarily by glomerular filtration. GFR estimating equations, based on serum concentrations of creatinine or cystatin C, are popular clinically and in research studies. Efforts are ongoing to improve these estimating equations for children and make the results readily available to clinicians obtaining standard chemistry profiles, as is being done for adults. However, at this time, there is no dependable substitute for an accurately determined GFR, and iohexol plasma disappearance offers the best combination of safety, accuracy, and reproducible precision.

Development of renal potassium excretion capacity in the neonatal rat

We investigated the capacity of newborn rats to excrete an acute potassium load to understand the development of a renal potassium excretion system. Three groups of the rats (7-14 d) were used to collect urine periodically over 6 h after oral infusion of potassium: control (no potassium loading) and low- and high-potassium-loaded rats. In the low-potassium-loaded group, infused with about 0.6 microEq of potassium chloride/g body wt., the rate of renal potassium excretion increased from 0.08 plus minus 0.02 (7 d) to 0.13 plus minus 0.02 (10 d) and 0.21 plus minus 0.03 (14 d) microEq/h/g body wt. The high-potassium-loaded rats (1.5-2.8 microEq/g body wt. potassium load) excreted potassium at a higher rate of 0.18 +/- 0.05 (7 d), 0.30 +/- 0.02 (10 d), and 0.45 +/- 0.10 (14 d) microEq/h/g body wt. They excreted 77% (7 d), 76% (10 d), and 95% (14 d) of the potassium load. These values were much larger than the rate of 0.026 microEq/h/g body wt. of the control rats and of 0.08 microEq/h/g body wt., a mean potassium excretion rate during development from 7 to 14 d calculated from the data in the previous study (Kanno T et al.: J. Pediatr. Gastr. Nutr. 24: 242-252, 1997). In the same period, serum potassium concentration in the newborn rats decreased significantly (p < 0.01) from 7.2 +/- 0.1 (7 d) to 6.7 +/- 0.1 mEq/l (14 d). All these results suggest that a renal potassium excretion system in the rat develops at least in the second week of life, and its capacity is high enough to excrete the daily potassium intake.

Renal compensation for body water loss during dehydration in neonatal rats

The present study was designed to investigate whether the limited capacity for concentrating urine in neonatal rats is associated with an immature ability to regulate serum osmolality. During milk deprivation, the percent of reduction in body weight per 10 h (mean +/- SE) was 4.3 +/- 0.2, 3.7 +/- 0.1, 4.8 +/- 0.2, and 6.0 +/- 0.1% in 4-, 7-, 10-, and 14-d-old rats, respectively (n = 23-24, each age). The osmolality of urine increased to 718 +/- 12 (4 d), 741 +/- 28 (7 d), 792 +/- 20 (10 d), and 1,203 +/- 41 mosmol/kg H2O (14 d). Free-water absorption (TcH2O) promptly increased after deprivation of milk: It significantly increased from 2.3 +/- 0.3 (0-4 h) to 3.4 +/- 0.1 (4-7 h) (4 d), from 3.1 +/- 0.3 to 4.1 +/- 0.3 (7 d), from 3. 6 +/- 0.4 to 5.2 +/- 0.3 (10 d), and from 5.0 +/- 0.4 to 7.9 +/- 0.7 microliter/min/100 g (14 d). The raised values were maintained at the later period of dehydration. Thus serum osmolality was unchanged throughout dehydration: 287 +/- 1.0 (7 d) and 292 +/- 0.9 mosmol/kg H2O (14 d). On the other hand, the level of serum sodium concentration slightly but significantly increased (r = 0.61) when the body weight reduction was higher than 5% of the control (14-d-old rats). These results indicate that neonatal rats of 4-14 d control their serum osmolality by reabsorbing free water in the kidney during the 10 or 12 h of milk deprivation.